MEDICARE: ALEXIS MCKENZIE SUTHERLAND APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	255049	SC
2	363LF0000X	Family Nurse Practitioner	31578	SC

General Provider Information

NPI Number	:	1629751185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MCKENZIE SUTHERLAND APRN, FNP-C

Provider Business Mailing Address
First Line	:	907 LONNIE ST
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-6043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 HIGHWAY 9 E
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7833
Country	:	US
Telephone Number	:	843-390-8304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2023
Last Update Date	:	03/09/2026

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